Prosthetic heart valve device and associated systems and methods

ABSTRACT

The present technology is a prosthetic heart valve device, and related systems and methods, for treating a native valve of a human heart having a native annulus and native leaflets. One embodiment comprises a valve support having an inflow region and an outflow region, and a prosthetic valve assembly within the valve support. The device further includes an anchoring member having a base attached to the outflow region of the valve support, a plurality of arms projecting laterally outward from the base and inclined in an upstream direction in a deployed state, and a fixation structure extending upstream from the arms. The fixation structure has a plurality of struts that define an annular engagement surface configured to press outwardly against the native annulus and a plurality of fixation elements projecting from the struts. The downstream-most portion of the fixation structure extends from the arms at a smooth bend, and fixation elements at the downstream-most portion of the fixation structure extend in an upstream direction.

This application is a divisional of U.S. patent application Ser. No. 15/490,047, filed Apr. 18, 2017. The entire contents of application Ser. No. 15/490,047 is incorporated herein by reference.

TECHNICAL FIELD

The present technology relates generally to prosthetic heart valve devices. Several embodiments of the present technology are well suited for percutaneous repair and/or replacement of native mitral valves.

BACKGROUND

Heart valves can be affected by several conditions. For example, mitral valves can be affected by mitral valve regurgitation, mitral valve prolapse and mitral valve stenosis. Mitral valve regurgitation is abnormal leaking of blood from the left ventricle into the left atrium caused by a disorder of the heart in which the leaflets of the mitral valve fail to coapt into apposition at peak contraction pressures. The mitral valve leaflets may not coapt sufficiently because heart diseases often cause dilation of the heart muscle, which in turn enlarges the native mitral valve annulus to the extent that the leaflets do not coapt during systole. Abnormal backflow can also occur when the papillary muscles are functionally compromised due to ischemia or other conditions. More specifically, as the left ventricle contracts during systole, the affected papillary muscles do not contract sufficiently to effect proper closure of the leaflets.

Mitral valve prolapse is a condition when the mitral leaflets bulge abnormally up in to the left atrium. This can cause irregular behavior of the mitral valve and lead to mitral valve regurgitation. The leaflets may prolapse and fail to coapt because the tendons connecting the papillary muscles to the inferior side of the mitral valve leaflets (chordae tendineae) may tear or stretch. Mitral valve stenosis is a narrowing of the mitral valve orifice that impedes filling of the left ventricle in diastole.

Mitral valve regurgitation is often treated using diuretics and/or vasodilators to reduce the amount of blood flowing back into the left atrium. Surgical approaches (open and intravascular) for either the repair or replacement of the valve have also been used to treat mitral valve regurgitation. For example, typical repair techniques involve cinching or resecting portions of the dilated annulus. Cinching, for example, includes implanting annular or peri-annular rings that are generally secured to the annulus or surrounding tissue. Other repair procedures suture or clip the valve leaflets into partial apposition with one another.

Alternatively, more invasive procedures replace the entire valve itself by implanting mechanical valves or biological tissue into the heart in place of the native mitral valve. These invasive procedures conventionally require large open thoracotomies and are thus very painful, have significant morbidity, and require long recovery periods. Moreover, with many repair and replacement procedures, the durability of the devices or improper sizing of annuloplasty rings or replacement valves may cause additional problems for the patient. Repair procedures also require a highly skilled cardiac surgeon because poorly or inaccurately placed sutures may affect the success of procedures.

Less invasive approaches to aortic valve replacement have been implemented in recent years. Examples of pre-assembled, percutaneous prosthetic valves include, e.g., the CoreValve Revalving® System from Medtronic/Corevalve Inc. (Irvine, Calif., USA) and the Edwards-Sapien® Valve from Edwards Lifesciences (Irvine, Calif., USA). Both valve systems include an expandable frame and a tri-leaflet bioprosthetic valve attached to the expandable frame. The aortic valve is substantially symmetric, circular, and has a muscular annulus. The expandable frames in aortic applications have a symmetric, circular shape at the aortic valve annulus to match the native anatomy, but also because tri-leaflet prosthetic valves require circular symmetry for proper coaptation of the prosthetic leaflets. Thus, aortic valve anatomy lends itself to an expandable frame housing a replacement valve since the aortic valve anatomy is substantially uniform, symmetric, and fairly muscular. Other heart valve anatomies, however, are not uniform, symmetric or sufficiently muscular, and thus transvascular aortic valve replacement devises may not be well suited for other types of heart valves.

BRIEF DESCRIPTION OF THE DRAWINGS

Many aspects of the present disclosure can be better understood with reference to the following drawings. The components in the drawings are not necessarily to scale, and instead emphasis is placed on illustrating clearly the principles of the present disclosure. Furthermore, components can be shown as transparent in certain views for clarity of illustration only and not to indicate that the illustrated component is necessarily transparent. For ease of reference, throughout this disclosure identical reference numbers and/or letters are used to identify similar or analogous components or features, but the use of the same reference number does not imply that the parts should be construed to be identical. Indeed, in many examples described herein, identically numbered components refer to different embodiments that are distinct in structure and/or function. The headings provided herein are for convenience only.

FIG. 1 is a schematic, cross-sectional illustration of the heart showing an antegrade approach to the native mitral valve from the venous vasculature in accordance with various embodiments of the present technology.

FIG. 2 is a schematic, cross-sectional illustration of the heart showing access through the inter-atrial septum (IAS) maintained by the placement of a guide catheter over a guidewire in accordance with various embodiments of the present technology.

FIGS. 3 and 4 are schematic, cross-sectional illustrations of the heart showing retrograde approaches to the native mitral valve through the aortic valve and arterial vasculature in accordance with various embodiments of the present technology.

FIG. 5 is a schematic, cross-sectional illustration of the heart showing an approach to the native mitral valve using a trans-apical puncture in accordance with various embodiments of the present technology.

FIG. 6A is a cross-sectional side view and FIG. 6B is a top view schematically illustrating a prosthetic heart valve device in accordance with an embodiment of the present technology.

FIGS. 7A and 7B are cross-sectional side views schematically illustrating aspects of delivering a prosthetic heart valve device in accordance with an embodiment of the present technology.

FIG. 8 is a top isometric view of a prosthetic heart valve device in accordance with an embodiment of the present technology.

FIG. 9A is a side view of the prosthetic heart valve device of FIG. 8, and FIG. 9B is a detailed view of a portion of the prosthetic heart valve device shown in FIG. 9A.

FIG. 10 is a bottom isometric view of the prosthetic heart valve device of FIG. 9A.

FIG. 11 is a side view and FIG. 12A is a bottom isometric view of a prosthetic heart valve device in accordance with an embodiment of the present technology.

FIG. 12B is an isometric view of a prosthetic heart valve device in accordance with another embodiment of the present technology, and FIG. 12C is a detailed view of a portion of the heart valve device shown in FIG. 12B.

FIG. 13 is a side view and FIG. 14 is a bottom isometric view of the prosthetic heart valve device of FIGS. 11 and 12 at a partially deployed state with respect to a delivery device.

FIG. 15 is a bottom isometric view of a valve support for use with prosthetic heart valve devices in accordance with the present technology.

FIGS. 16 and 17 are side and bottom isometric views, respectively, of a prosthetic heart valve attached to the valve support of FIG. 15.

FIGS. 18 and 19 are side views schematically showing valve supports in accordance with additional embodiments of the present technology.

FIG. 20 is a schematic view of an arm unit of an anchoring member for use with prosthetic heart valve devices in accordance with the present technology.

FIG. 21 is a schematic view of an arm unit of an anchoring member for use with prosthetic heart valve devices in accordance with the present technology.

FIG. 22 is a schematic view of a portion of the arm units of FIGS. 20 and 21 in accordance with the present technology.

FIG. 23 is a schematic view of an arm unit of an anchoring member for use with prosthetic heart valve devices in accordance with the present technology.

FIGS. 24A and 24B are schematic views showing arms having difference configurations of eyelets for coupling a sealing member to an anchoring member in accordance with the present technology.

DETAILED DESCRIPTION

Specific details of several embodiments of the technology are described below with reference to FIGS. 1-19. Although many of the embodiments are described below with respect to prosthetic valve devices, systems, and methods for percutaneous replacement of a native mitral valve, other applications and other embodiments in addition to those described herein are within the scope of the technology. Additionally, several other embodiments of the technology can have different configurations, components, or procedures than those described herein. A person of ordinary skill in the art, therefore, will accordingly understand that the technology can have other embodiments with additional elements, or the technology can have other embodiments without several of the features shown and described below with reference to FIGS. 1-19.

With regard to the terms “distal” and “proximal” within this description, unless otherwise specified, the terms can reference a relative position of the portions of a prosthetic valve device and/or an associated delivery device with reference to an operator and/or a location in the vasculature or heart. For example, in referring to a delivery catheter suitable to deliver and position various prosthetic valve devices described herein, “proximal” can refer to a position closer to the operator of the device or an incision into the vasculature, and “distal” can refer to a position that is more distant from the operator of the device or further from the incision along the vasculature (e.g., the end of the catheter). With respect to a prosthetic heart valve device, the terms “proximal” and “distal” can refer to the location of portions of the device with respect to the direction of blood flow. For example, proximal can refer to an upstream position or a location where blood flows into the device (e.g., inflow region), and distal can refer to a downstream position or a location where blood flows out of the device (e.g., outflow region).

Overview

Several embodiments of the present technology are directed to mitral valve replacement devices that address the unique challenges of percutaneously replacing native mitral valves and are well-suited to be recaptured in a percutaneous delivery device after being partially deployed for repositioning or removing the device. Compared to replacing aortic valves, percutaneous mitral valve replacement faces unique anatomical obstacles that render percutaneous mitral valve replacement significantly more challenging than aortic valve replacement. First, unlike relatively symmetric and uniform aortic valves, the mitral valve annulus has a non-circular D-shape or kidney-like shape, with a non-planar, saddle-like geometry often lacking symmetry. The complex and highly variable anatomy of mitral valves makes it difficult to design a mitral valve prosthesis that conforms well to the native mitral annulus of specific patients. As a result, the prosthesis may not fit well with the native leaflets and/or annulus, which can leave gaps that allows backflow of blood to occur. For example, placement of a cylindrical valve prosthesis in a native mitral valve may leave gaps in commissural regions of the native valve through which perivalvular leaks may occur.

Current prosthetic valves developed for percutaneous aortic valve replacement are unsuitable for use in mitral valves. First, many of these devices require a direct, structural connection between the stent-like structure that contacts the annulus and/or leaflets and the prosthetic valve. In several devices, the stent posts which support the prosthetic valve also contact the annulus or other surrounding tissue. These types of devices directly transfer the forces exerted by the tissue and blood as the heart contracts to the valve support and the prosthetic leaflets, which in turn distorts the valve support from its desired cylindrical shape. This is a concern because most cardiac replacement devices use tri-leaflet valves, which require a substantially symmetric, cylindrical support around the prosthetic valve for proper opening and closing of the three leaflets over years of life. As a result, when these devices are subject to movement and forces from the annulus and other surrounding tissues, the prostheses may be compressed and/or distorted causing the prosthetic leaflets to malfunction. Moreover, a diseased mitral annulus is much larger than any available prosthetic aortic valve. As the size of the valve increases, the forces on the valve leaflets increase dramatically, so simply increasing the size of an aortic prosthesis to the size of a dilated mitral valve annulus would require dramatically thicker, taller leaflets, and might not be feasible.

In addition to its irregular, complex shape, which changes size over the course of each heartbeat, the mitral valve annulus lacks a significant amount of radial support from surrounding tissue. Compared to aortic valves, which are completely surrounded by fibro-elastic tissue that provides sufficient support for anchoring a prosthetic valve, mitral valves are bound by muscular tissue on the outer wall only. The inner wall of the mitral valve anatomy is bound by a thin vessel wall separating the mitral valve annulus from the inferior portion of the aortic outflow tract. As a result, significant radial forces on the mitral annulus, such as those imparted by an expanding stent prostheses, could lead to collapse of the inferior portion of the aortic tract. Moreover, larger prostheses exert more force and expand to larger dimensions, which exacerbates this problem for mitral valve replacement applications.

The chordae tendineae of the left ventricle may also present an obstacle in deploying a mitral valve prosthesis. Unlike aortic valves, mitral valves have a maze of cordage under the leaflets in the left ventricle that restrict the movement and position of a deployment catheter and the replacement device during implantation. As a result, deploying, positioning and anchoring a valve replacement device on the ventricular side of the native mitral valve annulus is complicated.

Embodiments of the present technology provide systems, methods and apparatus to treat heart valves of the body, such as the mitral valve, that address the challenges associated with the anatomy of the mitral valve and provide for repositioning and removal of a partially deployed device. The apparatus and methods enable a percutaneous approach using a catheter delivered intravascularly through a vein or artery into the heart, or through a cannula inserted through the heart wall. For example, the apparatus and methods are particularly well-suited for trans-septal approaches, but can also be trans-apical, trans-atrial, and direct aortic delivery of a prosthetic replacement valve to a target location in the heart. Additionally, the embodiments of the devices and methods as described herein can be combined with many known surgeries and procedures, such as known methods of accessing the valves of the heart (e.g., the mitral valve or triscuspid valve) with antegrade or retrograde approaches, and combinations thereof.

The devices and methods described herein provide a valve replacement device that can be recaptured in a delivery device after being only partially deployed to reposition and/or remove the device. The device also has the flexibility to adapt and conform to the variably-shaped native mitral valve anatomy while mechanically isolating the prosthetic valve from the anchoring portion of the device. Several embodiments of the device effectively absorb the distorting forces applied by the native anatomy. The device has the structural strength and integrity necessary to withstand the dynamic conditions of the heart over time, thus permanently anchoring a replacement valve. The devices and methods further deliver such a device in a less-invasive manner, providing a patient with a new, permanent replacement valve but also with a lower-risk procedure and a faster recovery.

Access to the Mitral Valve

To better understand the structure and operation of valve replacement devices in accordance with the present technology, it is helpful to first understand approaches for implanting the devices. The mitral valve or other type of atrioventricular valve can be accessed through the patient's vasculature in a percutaneous manner. By percutaneous it is meant that a location of the vasculature remote from the heart is accessed through the skin, typically using a surgical cut down procedure or a minimally invasive procedure, such as using needle access through, for example, the Seldinger technique. The ability to percutaneously access the remote vasculature is well known and described in the patent and medical literature. Depending on the point of vascular access, access to the mitral valve may be antegrade and may rely on entry into the left atrium by crossing the inter-atrial septum (e.g., a trans-septal approach). Alternatively, access to the mitral valve can be retrograde where the left ventricle is entered through the aortic valve. Access to the mitral valve may also be achieved using a cannula via a trans-apical approach. Depending on the approach, the interventional tools and supporting catheter(s) may be advanced to the heart intravascularly and positioned adjacent the target cardiac valve in a variety of manners, as described herein.

FIG. 1 illustrates a stage of a trans-septal approach for implanting a valve replacement device. In a trans-septal approach, access is via the inferior vena cava IVC or superior vena cava SVC, through the right atrium RA, across the inter-atrial septum IAS, and into the left atrium LA above the mitral valve MV. As shown in FIG. 1, a catheter 1 having a needle 2 moves from the inferior vena cava IVC into the right atrium RA. Once the catheter 1 reaches the anterior side of the inter-atrial septum IAS, the needle 2 advances so that it penetrates through the septum, for example at the fossa ovalis FO or the foramen ovale into the left atrium LA. At this point, a guidewire replaces the needle 2 and the catheter 1 is withdrawn.

FIG. 2 illustrates a subsequent stage of a trans-septal approach in which guidewire 6 and guide catheter 4 pass through the inter-atrial septum IAS. The guide catheter 4 provides access to the mitral valve for implanting a valve replacement device in accordance with the technology.

In an alternative antegrade approach (not shown), surgical access may be obtained through an intercostal incision, preferably without removing ribs, and a small puncture or incision may be made in the left atrial wall. A guide catheter passes through this puncture or incision directly into the left atrium, sealed by a purse string-suture.

The antegrade or trans-septal approach to the mitral valve, as described above, can be advantageous in many respects. For example, antegrade approaches will usually enable more precise and effective centering and stabilization of the guide catheter and/or prosthetic valve device. The antegrade approach may also reduce the risk of damaging the chordae tendineae or other subvalvular structures with a catheter or other interventional tool. Additionally, the antegrade approach may decrease risks associated with crossing the aortic valve as in retrograde approaches. This can be particularly relevant to patients with prosthetic aortic valves, which cannot be crossed at all or without substantial risk of damage.

FIGS. 3 and 4 show examples of a retrograde approaches to access the mitral valve. Access to the mitral valve MV may be achieved from the aortic arch AA, across the aortic valve AV, and into the left ventricle LV below the mitral valve MV. The aortic arch AA may be accessed through a conventional femoral artery access route or through more direct approaches via the brachial artery, axillary artery, radial artery, or carotid artery. Such access may be achieved with the use of a guidewire 6. Once in place, a guide catheter 4 may be tracked over the guidewire 6. Alternatively, a surgical approach may be taken through an incision in the chest, preferably intercostally without removing ribs, and placing a guide catheter through a puncture in the aorta itself. The guide catheter 4 affords subsequent access to permit placement of the prosthetic valve device, as described in more detail herein. Retrograde approaches advantageously do not need a trans-septal puncture. Cardiologists also more commonly use retrograde approaches, and thus retrograde approaches are more familiar.

FIG. 5 shows a trans-apical approach via a trans-apical puncture. In this approach, access to the heart is via a thoracic incision, which can be a conventional open thoracotomy or sternotomy, or a smaller intercostal or sub-xyphoid incision or puncture. An access cannula is then placed through a puncture in the wall of the left ventricle at or near the apex of the heart. The catheters and prosthetic devices of the invention may then be introduced into the left ventricle through this access cannula. The trans-apical approach provides a shorter, straighter, and more direct path to the mitral or aortic valve. Further, because it does not involve intravascular access, the trans-apical approach does not require training in interventional cardiology to perform the catheterizations required in other percutaneous approaches.

Selected Embodiments of Prosthetic Heart Valve Devices and Methods

Embodiments of the present technology can treat one or more of the valves of the heart, and in particular several embodiments advantageously treat the mitral valve. The prosthetic valve devices of the present technology can also be suitable for replacement of other valves (e.g., a bicuspid or tricuspid valve) in the heart of the patient. Examples of prosthetic heart valve devices, system components and associated methods in accordance with embodiments of the present technology are described in this section with reference to FIGS. 6A-19. Specific elements, substructures, advantages, uses, and/or other features of the embodiments described with reference to FIGS. 6A-19 can be suitably interchanged, substituted or otherwise configured with one another. Furthermore, suitable elements of the embodiments described with reference to FIGS. 6A-19 can be used as stand-alone and/or self-contained devices.

FIG. 6A is a side cross-sectional view and FIG. 6B is a top plan view of a prosthetic heart valve device (“device”) 100 in accordance with an embodiment of the present technology. The device 100 includes a valve support 110, an anchoring member 120 attached to the valve support 110, and a prosthetic valve assembly 150 within the valve support 110. Referring to FIG. 6A, the valve support 110 has an inflow region 112 and an outflow region 114. The prosthetic valve assembly 150 is arranged within the valve support 110 to allow blood to flow from the inflow region 112 through the outflow region 114 (arrows BF), but prevent blood from flowing in a direction from the outflow region 114 through the inflow region 112.

In the embodiment shown in FIG. 6A, the anchoring member 120 includes a base 122 attached to the outflow region 114 of the valve support 110 and a plurality of arms 124 projecting laterally outward from the base 122. The anchoring member 120 also includes a fixation structure 130 extending from the arms 124. The fixation structure 130 can include a first portion 132 and a second portion 134. The first portion 132 of the fixation structure 130, for example, can be an upstream region of the fixation structure 130 that, in a deployed configuration as shown in FIG. 6A, is spaced laterally outward apart from the inflow region 112 of the valve support 110 by a gap G. The second portion 134 of the fixation structure 130 can be a downstream-most portion of the fixation structure 130. The fixation structure 130 can be a cylindrical ring (e.g., straight cylinder or conical), and the outer surface of the fixation structure 130 can define an annular engagement surface configured to press outwardly against the native annulus. The fixation structure 130 can further include a plurality of fixation elements 136 that project radially outward and are inclined toward an upstream direction. The fixation elements 136, for example, can be barbs, hooks, or other elements that are inclined only in the upstream direction (e.g., a direction extending away from the downstream portion of the device 100).

Referring still to FIG. 6A, the anchoring member 120 has a smooth bend 140 between the arms 124 and the fixation structure 130. For example, the second portion 134 of the fixation structure 130 extends from the arms 124 at the smooth bend 140. The arms 124 and the fixation structure 130 can be formed integrally from a continuous strut or support element such that the smooth bend 140 is a bent portion of the continuous strut. In other embodiments, the smooth bend 140 can be a separate component with respect to either the arms 124 or the fixation structure 130. For example, the smooth bend 140 can be attached to the arms 124 and/or the fixation structure 130 using a weld, adhesive or other technique that forms a smooth connection. The smooth bend 140 is configured such that the device 100 can be recaptured in a capsule or other container after the device 100 has been at least partially deployed.

The device 100 can further include a first sealing member 162 on the valve support 110 and a second sealing member 164 on the anchoring member 120. The first and second sealing members 162, 164 can be made from a flexible material, such as Dacron® or another type of polymeric material. The first sealing member 162 can cover the interior and/or exterior surfaces of the valve support 110. In the embodiment illustrated in FIG. 6A, the first sealing member 162 is attached to the interior surface of the valve support 110, and the prosthetic valve assembly 150 is attached to the first sealing member 162 and commissure portions of the valve support 110. The second sealing member 164 is attached to the inner surface of the anchoring member 120. As a result, the outer annular engagement surface of the fixation structure 130 is not covered by the second sealing member 164 so that the outer annular engagement surface of the fixation structure 130 directly contacts the tissue of the native annulus.

The device 100 can further include an extension member 170. The extension member 170 can be an extension of the second sealing member 164, or it can be a separate component attached to the second sealing member 164 and/or the first portion 132 of the fixation structure 130. The extension member 170 can be a flexible member that, in a deployed state as shown in FIG. 6A, flexes relative to the first portion 132 of the fixation structure 130. In operation, the extension member 170 provides tactile feedback or a visual indicator (e.g., on echocardiographic or fluoroscopic imaging systems) to guide the device 100 during implantation such that the device is located at a desired elevation and centered relative to the native annulus. As described below, the extension member 170 can include a support member, such as a metal wire or other structure, that can be visualized during implantation. For example, the support member can be a radiopaque wire.

FIGS. 7A and 7B are cross-sectional views illustrating an example of the operation of the smooth bend 140 between the arms 124 and the fixation structure 130 in the recapturing the device 100 after partial deployment. FIG. 7A schematically shows the device 100 loaded into a capsule 700 of a delivery system in a delivery state, and FIG. 7B schematically shows the device 100 in a partially deployed state. Referring to FIG. 7A, the capsule 700 has a housing 702, a support 704, and a top 706. In the delivery state shown in FIG. 7A, the device 100 is in a low-profile configuration suitable for delivery through a catheter or cannula to a target implant site at a native heart valve.

Referring to FIG. 7B, the housing 702 of the capsule 700 has been moved distally such that the extension member 170, fixation structure 130 and a portion of the arms 124 have been released from the housing 702 in a partially deployed state. This is useful for locating the fixation structure 130 at the proper elevation relative to the native valve annulus A such that the fixation structure 130 expands radially outward and contacts the inner surface of the native annulus A. However, the device 100 may need to be repositioned and/or removed from the patient after being partially deployed. To do this, the housing 702 is retracted (arrow R) back toward the fixation structure 130. As the housing 702 slides along the arms 124, the smooth bend 140 between the arms 124 and the fixation structure 130 allows the edge 708 of the housing 702 to slide over the smooth bend 140 and thereby recapture the fixation structure 130 and the extension member 170 within the housing 702. The device 100 can then be removed from the patient or repositioned for redeployment at a better location relative to the native annulus A. Further aspects of prosthetic heart valve devices in accordance with the present technology and their interaction with corresponding delivery devices are described below with reference to FIGS. 8-19.

FIG. 8 is a top isometric view of an example of the device 100. In this embodiment, the valve support 110 defines a first frame (e.g., an inner frame) and fixation structure 130 of the anchoring member 120 defines a second frame (e.g., an outer frame) that each include a plurality of structural elements. The fixation structure 130, more specifically, includes structural elements 137 arranged in diamond-shaped cells 138 that together form at least a substantially cylindrical ring when freely and fully expanded as shown in FIG. 8. The structural elements 137 can be struts or other structural features formed from metal, polymers, or other suitable materials that can self-expand or be expanded by a balloon or other type of mechanical expander.

Several embodiments of the fixation structure 130 can be a generally cylindrical fixation ring having an outwardly facing engagement surface. For example, in the embodiment shown in FIG. 8, the outer surfaces of the structural elements 137 define an annular engagement surface configured to press outwardly against the native annulus in the deployed state. In a fully expanded state without any restrictions, the fixation structure 130 is at least substantially parallel to the valve support 110. However, the fixation structure 130 can flex inwardly (arrow I) in the deployed state when it presses radially outwardly against the inner surface of the native annulus of a heart valve.

The embodiment of the device 100 shown in FIG. 8 includes the first sealing member 162 lining the interior surface of the valve support 110, and the second sealing member 164 along the inner surface of the fixation structure 130. The extension member 170 has a flexible web 172 (e.g., a fabric) and a support member 174 (e.g., metal or polymeric strands) attached to the flexible web 172. The flexible web 172 can extend from the second sealing member 164 without a metal-to-metal connection between the fixation structure 130 and the support member 174. For example, the extension member 170 can be a continuation of the material of the second sealing member 164. Several embodiments of the extension member 170 are thus a floppy structure that can readily flex with respect to the fixation structure 130. The support member 174 can have a variety of configurations and be made from a variety of materials, such as a double-serpentine structure made from Nitinol.

FIG. 9A is a side view, FIG. 9B is a detailed view of a portion of FIG. 9A, and FIG. 10 is a bottom isometric view of the device 100 shown in FIG. 8. Referring to FIG. 9A, the arms 124 extend radially outward from the base portion 122 at an angle a selected to position the fixation structure 130 radially outward from the valve support 110 (FIG. 8) by a desired distance in a deployed state. The angle a is also selected to allow the edge 708 of the housing 702 (FIG. 7B) to slide from the base portion 122 toward the fixation structure 130 during recapturing. In many embodiments, the angle a is 15°-75°, or more specifically 15°-60°, or still more specifically 30°-45°. The arms 124 and the structural elements 137 of the fixation structure 130 can be formed from the same struts (i.e., formed integrally with each other) such that the smooth bend 140 is a continuous, smooth transition from the arms 124 to the structural elements 137. This is expected to enable the edge 708 of the housing 702 to more readily slide over the smooth bend 140 in a manner that allows the fixation structure 130 to be recaptured in the housing 702 of the capsule 700 (FIG. 7B). Additionally, by integrally forming the arms 124 and the structural elements 137 with each other, it reduces the potential of breaking the device 100 at a junction between the arms 124 and the structural elements 137 compared to a configuration in which the arms 124 and structural elements 137 are separate components and welded or otherwise fastened to each other. FIGS. 9A and 9B also show that the device 100 can further include chevron-support struts at the outflow region that extend between the arms 124 at the base 122 of the anchoring member 120. The chevron-supports at the base 122 do not necessarily have a “smooth bend,” such as the smooth bend 140 at the transition from the arms 124 to the downstream-most portion of the fixation structure 130. As such, so long as the chevron-supports and other elements of the device 100 project toward the inflow region to allow recapture, certain portions of the device 100, and the anchoring member 120 in particular, need not have such a smooth bend.

Referring to FIGS. 9B and 10, the arms 124 are arranged in V-shaped arm units 125 that each have a pair of arms 124 extending from a bifurcation 127 at the base portion 122. In this embodiment, the individual arms 124 in each V-shaped arm unit 125 are separated from each other along their entire length from where they are connected to the base portion 122 through the smooth bend 140 (FIG. 9A) to the structural elements 137 of the fixation structure 130. The individual arms 124 are thus able to readily flex as the edge 708 of the housing 702 (FIG. 7B) slides along the arms 124 during recapturing. This is expected to reduce the likelihood that the edge 708 of the housing 702 will catch on the arms 124 and prevent the device 100 from being recaptured in the housing 702.

In one embodiment, the arms 124 have a first length from the base 122 to the smooth bend 140, and the structural elements 137 of the fixation structure 130 at each side of a cell 138 (FIG. 8) have a second length. The second length of the structural elements 137 along each side of a cell 138 is less than the first length of the arms 124. The fixation structure 130 is accordingly less flexible than the arms 124. As a result, the fixation structure 130 is able to press outwardly against the native annulus with sufficient force to secure the device 100 to the native annulus, while the arms 124 are sufficiently flexible to fold inwardly when the device is recaptured in a delivery device.

In the embodiment illustrated in FIGS. 8-10, the arms 124 and the structural elements 137 are configured such that each arm 124 and the two structural elements 137 extending from each arm 124 formed a Y-shaped portion 142 (FIG. 10) of the anchoring member 120. Additionally, the right-hand structural element 137 of each Y-shaped portion 142 is coupled directly to a left-hand structural element 137 of an immediately adjacent Y-shaped portion 142. The Y-shaped portions 142 and the smooth bends 140 are expected to further enhance the ability to slide the housing 702 along the arms 124 and the fixation structure 130 during recapturing.

FIG. 11 is a side view and FIG. 12A is a bottom isometric view of a prosthetic heart valve device (“device”) 200 in accordance with another embodiment of the present technology. The device 200 is shown without the extension member 170 (FIGS. 8-10), but the device 200 can further include the extension member 170 described above. The base 122 of the device 200 shown in FIG. 12A further includes only a single row of chevron-supports 216 as opposed to the dual-rows of chevron-supports at the base 122 of the device 100 shown in FIG. 10. The device 200 further includes extended connectors 210 projecting from the base 122 of the anchoring member 120. Alternatively, the extended connectors 210 can extend from the valve support 110 (FIGS. 6A-10) in addition to or in lieu of extending from the base 122 of the anchoring member 120. The extended connectors 210 can include a first strut 212 a attached to one portion of the base 122 and a second strut 212 b attached to another portion of the base 122. The first and second struts 212 a-b are configured to form a V-shaped structure in which they extend toward each other in a downstream direction and are connected to each other at the bottom of the V-shaped structure. The V-shaped structure of the first and second struts 212 a-b causes the extension connector 210 to elongate when the device 200 is in a low-profile configuration within the capsule 700 (FIG. 7A) during delivery or partial deployment. When the device 200 is fully released from the capsule 700 (FIG. 7A) the extension connectors 210 foreshorten to avoid interfering with blood flow along the left ventricular outflow tract.

The extended connectors 210 further include an attachment element 214 configured to releasably engage a delivery device. The attachment element 214 can be a T-bar or other element that prevents the device 200 from being released from the capsule 700 (FIG. 7A) of a delivery device until desired. For example, a T-bar type attachment element 214 can prevent the device 200 from moving axially during deployment or partial deployment until the housing 702 (FIG. 7A) moves distally beyond the attachment elements 214 such that the outflow region of the valve support 110 and the base 122 of the anchoring member 120 can fully expand upon full deployment.

FIG. 12B is an isometric view of a prosthetic heart valve device 200 a (“device 200 a”) in accordance with another embodiment of the present technology, and FIG. 12C is a detailed view of an arm unit of the device 200 a. The device 200 a is substantially similar to the device 200 shown in FIG. 12A, but the device 200 a includes a plurality of Y-shaped arm units 224 instead of V-shaped arm units. Referring to FIG. 12C, the arm units 224 have a trunk 226 and two arms 228 extending from the trunk 226 at a bifurcation 227. The trunk 226 of each Y-shaped arm unit 224 extends from a single row of chevron-supports 216 at the base 122 of the anchoring member 120, and the trunks 226 have a length such that the bifurcations 227 are located a distance apart from the base 122. The arms 228 of the Y-shaped arm units 224 can be slightly shorter than the arms 124 of the V-shaped arm units 125 described above with respect to FIG. 9B, but the overall lengths of the Y-shaped and V-shaped arm units 224 and 125 can be about the same. The Y-shaped arm units 224 reduce the amount of metal in the region of the chevron-supports 216 compared to the V-shaped arm units 125, which reduces the material at the base 122 of the anchoring member 120 so that the device 200 a can be crimped to a smaller diameter for delivery. Moreover, the Y-shaped arm units 224 are also sufficiently flexible so that the device 200 a can be resheathed in a capsule of a delivery device. FIG. 13 is a side view and FIG. 14 is a bottom isometric view of the device 200 in a partially deployed state in which the device 200 is still capable of being recaptured in the housing 702 of the delivery device 700. Referring to FIG. 13, the device 200 is partially deployed with the fixation structure 130 substantially expanded but the attachment elements 214 (FIG. 11) still retained within the capsule 700. This is useful for determining the accuracy of the position of the device 200 and allowing blood to flow through the functioning replacement valve during implantation while retaining the ability to recapture the device 200 in case it needs to be repositioned or removed from the patient. In this state of partial deployment, the elongated first and second struts 212 a-b of the extended connectors 210 space the base 122 of the anchoring member 120 and the outflow region of the valve support 110 (FIG. 6A) apart from the edge 708 of the capsule 702 by a gap G.

Referring to FIG. 14, the gap G enables blood to flow through the prosthetic valve assembly 150 while the device 200 is only partially deployed. As a result, the device 200 can be partially deployed to determine (a) whether the device 200 is positioned correctly with respect to the native heart valve anatomy and (b) whether proper blood flow passes through the prosthetic valve assembly 150 while the device 200 is still retained by the delivery system 700. As such, the device 200 can be recaptured if it is not in the desired location and/or if the prosthetic valve is not functioning properly. This additional functionality is expected to significantly enhance the ability to properly position the device 200 and assess, in vivo, whether the device 200 will operate as intended, while retaining the ability to reposition the device 200 for redeployment or remove the device 200 from the patient.

FIG. 15 is a bottom isometric view of a valve support 300 in accordance with an embodiment of the present technology. The valve support 300 can be an embodiment of the valve support 110 described above with respect to FIGS. 6A-14. The valve support 300 has an outflow region 302, an inflow region 304, a first row 310 of first hexagonal cells 312 at the outflow region 302, and a second row 320 of second hexagonal cells 322 at the inflow region 304. The valve support shown in FIG. 15 is inverted compared to the valve support 100 shown in FIGS. 6A-14 for purposes of illustration such that the blood flows through the valve support 300 in the direction of arrow BF. In mitral valve applications, the valve support 300 would be positioned within the anchoring member 120 (FIG. 6A) such that the inflow region 304 would correspond to orientation of the inflow region 112 in FIG. 6A and the outflow region 302 would correspond to the orientation of the outflow region 114 in FIG. 6A.

Each of the first hexagonal cells 312 includes a pair of first longitudinal supports 314, a downstream apex 315, and an upstream apex 316. Each of the second hexagonal cells 322 can include a pair of second longitudinal supports 324, a downstream apex 325, and an upstream apex 326. The first and second rows 310 and 320 of the first and second hexagonal cells 312 and 322 are directly adjacent to each other. In the illustrated embodiment, the first longitudinal supports 314 extend directly from the downstream apexes 325 of the second hexagonal cells 322, and the second longitudinal supports 324 extend directly from the upstream apexes 316 of the first hexagonal cells 312. As a result, the first hexagonal cells 312 are offset circumferentially from the second hexagonal cells 322 around the circumference of the valve support 300 by half of the cell width.

In the embodiment illustrated in FIG. 15, the valve support 300 includes a plurality of first struts 331 at the outflow region 302, a plurality of second struts 332 at the inflow region 304, and a plurality of third struts 333. Each of the first struts 331 extends from a downstream end of the first longitudinal supports 314, and pairs of the first struts 331 are connected together to form first downstream V-struts defining the downstream apexes 315 of the first hexagonal cells 312. In a related sense, each of the second struts 332 extends from an upstream end of the second longitudinal supports 324, and pairs of the second struts 332 are connected together to form second upstream V-struts defining the upstream apexes 326 of the second hexagonal cells 322. Each of the third struts 333 has a downstream end connected to an upstream end of the first longitudinal supports 314, and each of the third struts 333 has an upstream end connected to a downstream end of one of the second longitudinal supports 324. The downstream ends of the third struts 333 accordingly define a second downstream V-strut arrangement that forms the downstream apexes 325 of the second hexagonal cells 322, and the upstream ends of the third struts 333 define a first upstream V-strut arrangement that forms the upstream apexes 316 of the first hexagonal cells 312. The third struts 333, therefore, define both the first upstream V-struts of the first hexagonal cells 312 and the second downstream V-struts of the second hexagonal cells 322.

The first longitudinal supports 314 can include a plurality of holes 336 through which sutures can pass to attach a prosthetic valve assembly and/or a sealing member. In the embodiment illustrated in FIG. 15, only the first longitudinal supports 314 have holes 336. However, in other embodiments the second longitudinal supports 324 can also include holes either in addition to or in lieu of the holes 336 in the first longitudinal supports 314.

FIG. 16 is a side view and FIG. 17 is a bottom isometric view of the valve support 300 with a first sealing member 162 attached to the valve support 300 and a prosthetic valve 150 within the valve support 300. The first sealing member 162 can be attached to the valve support 300 by a plurality of sutures 360 coupled to the first longitudinal supports 314 and the second longitudinal supports 324. At least some of the sutures 360 coupled to the first longitudinal supports 314 pass through the holes 336 to further secure the first sealing member 162 to the valve support 300. Sutures 360 can also pass through the holes 336 if holes 336 are included in addition to or in lieu of the holes 336 of the first longitudinal supports 314.

Referring to FIG. 17, the prosthetic valve 150 can be attached to the first sealing member 162 and/or the first longitudinal supports 314 of the valve support 300. For example, the commissure portions of the prosthetic valve 150 can be aligned with the first longitudinal supports 314, and the sutures 360 can pass through both the commissure portions of the prosthetic valve 150 and the first sealing member 162 where the commissure portions of the prosthetic valve 150 are aligned with a first longitudinal support 314. The inflow portion of the prosthetic valve 150 can be sewn to the first sealing member 162.

The valve support 300 illustrated in FIGS. 15-17 is expected to be well suited for use with the device 100 and 200 and described above with reference to FIGS. 8-10 and 11-14, respectively. More specifically, the first struts 331 cooperate with the base of the anchoring member 122. The first struts 331, for example, elongate when the valve support 300 is not fully expanded compared to when the valve support is fully expanded. In addition to the elongation of the struts, the position of the prosthetic valve 150 within the valve support 300 allows the outflow portion of the prosthetic valve 150 to be spaced further apart from the capsule 700 in a partially deployed state so that the prosthetic valve 150 can at least partially function in the partially deployed state. Alternatively, if attached to the device 200, the extended connectors 210 (FIGS. 11-14) of the device 200 serve to further separate the outflow portion of the prosthetic valve 150 from the capsule 700 (FIGS. 13-14) when the device 200 is in a partially deployed state, allowing for partial function of the prosthetic valve 150. Upon full deployment, the first struts 331 foreshorten. Therefore, the valve support 300 is expected to enhance the ability to assess whether the prosthetic valve 150 is fully operational in a partially deployed state. This additional functionality is expected to significantly enhance the ability to assess, in vivo, whether the device 100 and 200 will operate as intended, while retaining the ability to reposition the device 100 and 200 for redeployment or remove the device 100 and 200 from the patient.

FIGS. 18 and 19 are schematic side views of valve supports 400 and 500, respectively, in accordance with embodiments of the present technology. The valve support 400 includes a first row 410 of first of hexagonal cells 412 and a second row 420 of second hexagonal cells 422. The valve 400 can further include a first row 430 of diamond-shaped cells extending from the first hexagonal cells 412 and a second row 440 of diamond-shaped cells extending from the second hexagonal cells 422. The additional diamond-shaped cells elongate in the low-profile state, and thus they can further space the prosthetic valve 150 (shown schematically) apart from the capsule of the delivery device, enhancing the ability to assess, in vivo, whether the device will operate as intended while retaining the ability to reposition or remove the device from the patient. Referring to FIG. 19, the valve support 500 includes a first row 510 of first hexagonal cells 512 at an outflow region 502 and a second row 520 of second hexagonal cells 522 at an inflow region 504. The valve support 500 is shaped such that an intermediate region 506 has a smaller cross-sectional area than that of the outflow region 502 and/or the inflow region 504. As such, the first row 510 of first hexagonal cells 512 flares outwardly in the downstream direction and the second row 520 of second hexagonal cells 522 flares outwardly in the upstream direction. The flared outflow and inflow regions 502 and 504 are expected to improve blood flow through the valve support 500. Additionally, the flared outflow and inflow regions 502 and 504 reduce the length of the valve support compared to a straight cylindrical design, which reduces the amount that the valve support 500 extends into the left ventricle.

FIG. 20 is a schematic view showing a portion of an anchoring member 120 in accordance with an embodiment of the present technology. In this embodiment, the anchoring member 120 includes the fixation structure 130 and V-shaped arm units 620 (only a single arm unit shown). Each V-shaped arm unit 620 includes a pair of arms 622 extending from the base 122 to the fixation structure 130 (only a portion shown), and each arm 622 includes a first portion 624 having a first flexibility and a second portion 626 with a second flexibility less than the first flexibility. The first portion 624 of the arms 622 are selectively flexible at the base 122 of the anchoring member 120, while the second portion 626 of the arms 622 have sufficient stiffness to push the fixation structure 130 radially outwardly for engaging the native annulus. In the illustrated embodiment, the first portion 624 of the arms 622 are a serpentine member (e.g., an according connector), and the second portion 626 of the arms 622 are straighter than the first portion 624. For example the second portion 626 of the arms 622 can curve radially outward along an arc (e.g. a single arc) as opposed to the serpentine or the zig-zag configuration of the first portion 624.

FIG. 21 is a schematic view showing a portion of another anchoring member 120 in accordance with an embodiment of the present technology including Y-shaped arm units 720 (only a single arm unit 720 shown). Each Y-shaped arm unit 720 has a trunk 724 and arms 726 extending from the trunk 724. The trunk 724 has a first flexibility, and the arms 726 have a second flexibility less than the first flexibility. The trunk 724, for example, is a strut having a serpentine configuration (e.g., an accordion connector), and the arms 726 can be curved struts extending radially outward from the trunk 724 in an expanded configuration.

FIG. 22 schematically illustrates the operation of the arm units 620 and 720 shown in FIGS. 20 and 21. In operation, the native annulus (not shown) exerts a compressive annulus force F_(A) against the fixation structure 130 while the systolic pressure creates a force F_(P). The additional flexibility of the first portion 624 or the trunk 724 allows the arm units 620 and 720 to preferentially flex near the outflow end of the valve support 110 to allow the fixation structure 130 to be deformed by the native annulus while mitigating the commissure forces Fc exerted against the valve support 110 at the base 122. Notably, the second portion 626 of the arms 622 and the arms 726 are sufficiently stiff to provide the desired radially outward force against the native annulus for securing the prosthetic heart valve device at the native heart valve.

FIG. 23 illustrates an arm 800 supporting a fixation structure 130 in accordance with another embodiment of the present technology. The arm 800 can include a first portion 820 configured to be coupled to the outflow region of a valve support and a second portion 822 extending from the first portion 820 to the fixation structure 130. The first portion 820 of the arm 800 can correspond to the first portion 624 of the arms 622 of the V-shaped arm unit 620 or the trunk 724 of the Y-shaped arm unit 720. The first portion 820 of the arm 800 can further include a plurality of outward recesses 824 (e.g., notches) that enable the first portion 822 preferentially flex outward (arrow O). The arm 800 is expected to perform substantially similarly to the arms 622 and the Y-shaped arm unit 720 described above with reference to FIGS. 20-22.

FIGS. 24A and 24B are schematic views showing arms 124 having difference configurations of eyelets 900 for coupling the second sealing member 164 (FIGS. 6A and 6B) to the anchoring member 120. Referring to FIG. 24A, the eyelets 900 are on the outside of the arms 124. Referring to FIG. 24B, the eyelets are on the inside of the arms 124. In both embodiments, sutures 902 pass through the eyelets to attach the second sealing member 164 to the inside of the anchoring member 120. The embodiment shown in FIG. 24B is particularly well-suited for resheathing the prosthetic heart valve devices because the eyelets are shape-set to extend inwardly to eliminate or otherwise limit protrusions relative to the outer surface of the arms 124 that could inhibit the capsule from sliding over the arms 124 during resheathing.

Examples

Several aspects of the present technology described above are embodied in the following examples.

-   1. A prosthetic heart valve device for treating a native valve of a     human heart having a native annulus and native leaflets, comprising:     -   a valve support having an inflow region and an outflow region;     -   a prosthetic valve assembly within the valve support; and     -   an anchoring member having a base attached to the outflow region         of the valve support, a plurality of arms projecting laterally         outward from the base and inclined in an upstream direction in a         deployed state, and a fixation structure extending upstream from         the arms, the fixation structure having a plurality of struts         that define an annular engagement surface configured to press         outwardly against the native annulus and a plurality of fixation         elements projecting from the struts, wherein a downstream-most         portion of the fixation structure extends from the arms at a         smooth bend and fixation elements at the downstream-most portion         of the fixation structure extend in an upstream direction. -   2. The prosthetic heart valve device of example 1 wherein the arms     are spaced apart from each other throughout their length. -   3. The prosthetic heart valve device of any of examples 1-2 wherein     the struts of the fixation structure are arranged in cells having     sides, and the arms have a first length and each side of the cells     has a second length less than the first length. -   4. The prosthetic heart valve device of any of examples 1-3 wherein     each arm and the struts of the fixation structure extending from     each arm form a Y-shaped portion of the anchoring member, and a     right-hand strut of each Y-shaped portion is coupled directly to a     left-hand strut of an immediately adjacent Y-shaped portion. -   5. The prosthetic heart valve device of any of examples 1-4, further     comprising connector extensions projecting from a downstream end of     the valve support and/or the base, and wherein each connector     extension has first and second struts forming a V-shaped structure     extending downstream from the valve support and/or the base, and a     connector projecting downstream from the V-shaped structure, wherein     the connector is configured to be releasably held by a delivery     device. -   6. The prosthetic heart valve device of any of examples 1-5 wherein     all of the fixation elements projecting from the fixation structure     extend in an upstream direction. -   7. The prosthetic heart valve device of any of examples 1-6 wherein     the valve support comprises:     -   a first row of first hexagonal cells at the outflow region of         the valve support, and the first hexagonal cells having first         longitudinal supports;     -   a second row of second hexagonal cells at the inflow region of         the valve support, the second hexagonal cells having second         longitudinal supports, wherein the first and second hexagonal         cells are directly adjacent to each other such that the first         longitudinal supports extend directly from downstream apexes of         the second hexagonal cells and the second longitudinal supports         extend directly from upstream apexes of the first hexagonal         cells; and     -   wherein the prosthetic valve assembly is attached to at least         one of the first longitudinal supports and/or at least one of         the second longitudinal supports. -   8. The prosthetic heart valve device of example 7 wherein the valve     support further comprises a first row of diamond-shaped cells at a     downstream end of the first row of hexagonal cells and a second row     of diamond-shaped cells at an upstream end of the second row of     hexagonal cells. -   9. The prosthetic heart valve device of example 7 wherein the first     row of hexagonal cells flares outward in the downstream direction     and the second row of hexagonal cells flares outward in the upstream     direction. -   10. The prosthetic heart valve device of example 7, further     comprising connector extensions projecting from a downstream end of     the valve support and/or the base, and wherein each connector     extension has first and second struts forming a V-shaped structure     extending downstream from the valve support and/or the base, and a     connector projecting downstream from the V-shaped structure, wherein     the connector is configured to be releasably held by a delivery     device. -   11. The prosthetic heart valve device of any of examples 1-10     wherein the valve support comprises:     -   a first row of first hexagonal cells at the outflow region of         the valve support, wherein the first hexagonal cells have first         longitudinal supports, first upstream V-struts extending         upstream from the first longitudinal supports, and first         downstream V-struts extending downstream from the first         longitudinal supports;     -   a second row of second hexagonal cells at the inflow region of         the valve support, wherein the second hexagonal cells have         second longitudinal supports, second upstream V-struts extending         upstream from the second longitudinal supports, and second         downstream V-struts extending downstream from the second         longitudinal supports; and     -   wherein the first upstream V-struts of the first hexagonal cells         and the second downstream inverted V-struts of the second         hexagonal cells are the same struts. -   12. A prosthetic heart valve device for treating a native valve of a     human heart having a native annulus and native leaflets, comprising:     -   an annular inner support frame having an inflow region and an         outflow region;     -   a prosthetic valve assembly within the inner support frame; and     -   an anchoring member having a base attached to the outflow region         of the inner support frame, a plurality of arms projecting         laterally outward from the base at an angle inclined in an         upstream direction, and an outer fixation frame extending         upstream from the arms, the outer fixation frame having a         plurality of struts that define an annular engagement surface         spaced radially outward from the inflow region of the inner         support frame in the deployed state, wherein the arms and the         struts are configured to be partially deployed from a capsule         and then at least substantially recaptured within the capsule by         moving at least one of the capsule and/or the device relative to         the other such the arms and struts slide into the capsule. -   13. The prosthetic heart valve device of example 12 wherein the arms     are spaced apart from each other throughout their length. -   14. The prosthetic heart valve device of any of examples 12-13     wherein the struts of the outer fixation frame are arranged in cells     having sides, and the arms have a first length and each side of the     cells has a second length less than the first length. -   15. The prosthetic heart valve device of any of examples 12-14     wherein each arm and the struts of the outer fixation frame     extending from each arm form a Y-shaped portion of the anchoring     member, and a right-hand strut of each Y-shaped portion is coupled     directly to a left-hand strut of an immediately adjacent Y-shaped     portion. -   16. The prosthetic heart valve device of any of examples 12-15,     further comprising connector extensions projecting from a downstream     end of the inner annular support frame and/or the base, and wherein     each connector extension has first and second struts forming a     V-shaped structure extending downstream from the inner annular     support frame and/or the base, and a connector projecting downstream     from the V-shaped structure, wherein the connector is configured to     be releasably held by a delivery device. -   17. The prosthetic heart valve device of any of examples 12-16,     further comprising fixation elements projecting from the outer     fixation frame, and wherein all of the fixation elements project     from the outer fixation frame extend in an upstream direction. -   18. The prosthetic heart valve device of any of examples 12-17     wherein the inner annular support frame comprises:     -   a first row of first hexagonal cells at the outflow region of         the inner annular support frame, and the first hexagonal cells         having first longitudinal supports;     -   a second row of second hexagonal cells at the inflow region of         the inner annular support frame, the second hexagonal cells         having second longitudinal supports, wherein the first and         second hexagonal cells are directly adjacent to each other such         that the first longitudinal supports extend directly from         downstream apexes of the second hexagonal cells and the second         longitudinal supports extend directly from upstream apexes of         the first hexagonal cells; and     -   wherein the prosthetic valve assembly is attached to at least         one of the first longitudinal supports and/or at least one of         the second longitudinal supports. -   19. The prosthetic heart valve device of example 18 wherein the     inner annular support frame further comprises a first row of     diamond-shaped cells at a downstream end of the first row of     hexagonal cells and a second row of diamond-shaped cells at an     upstream end of the second row of hexagonal cells. -   20. The prosthetic heart valve device of example 18 wherein the     first row of hexagonal cells flares outward in the downstream     direction and the second row of hexagonal cells flares outward in     the upstream direction. -   21. The prosthetic heart valve device of example 18, further     comprising connector extensions projecting from a downstream end of     the inner annular support frame and/or the base, and wherein each     connector extension has first and second struts forming a V-shaped     structure extending downstream from the inner annular support frame     and/or the base, and a connector projecting downstream from the     V-shaped structure, wherein the connector is configured to be     releasably held by a delivery device. -   22. The prosthetic heart valve device of any of examples 1-21     wherein the arms are arranged in pairs defining V-shaped arm units. -   23. The prosthetic heart valve device of example 22 wherein the     V-shaped arm units have a pair of arm, and each arm has a first     portion having a first flexibility and a second portion having a     second flexibility less than the first flexibility. -   24. The prosthetic heart valve device of example 23 wherein the     first portion has a serpentine configuration. -   25. the prosthetic heart valve device of example 23 wherein the     first portion has outwardly open notches. -   26. The prosthetic heart valve device of any of examples 1, 3-12 and     14-21 wherein the arms are arranged in Y-shaped arm units having a     trunk and a pair of arms extending from the trunk. -   27. The prosthetic heart valve device of examples 26 wherein the     trunk has a first flexibility and the arms have a second flexibility     less than the first flexibility. -   28. The prosthetic heart valve device of example 27 wherein the     trunk has a serpentine configuration. -   29. The prosthetic heart valve device of example 27 wherein the     trunk has a plurality of outwardly open notches. -   30. A method of deploying a prosthetic heart valve device for     treating a native heart valve, comprising:     -   partially deploying a prosthetic heart valve device from a         capsule of a delivery device such that an inflow region of a         valve support and an inflow region of a fixation structure are         expanded radially outward relative to the capsule with the         inflow region of the fixation structure being spaced radially         outward of the valve support, wherein an outflow region of the         valve support and/or the fixation structure remains within the         capsule, and wherein a gap exists between a downstream end of a         prosthetic valve within the valve support and a distal terminus         of the capsule such that fluid can flow through the valve while         the outflow region is within the capsule; and     -   recapturing the prosthetic heart valve device within the         capsule. -   31. The method of example 30 wherein the native heart valve is a     native mitral valve. -   32. The method of example 30 wherein the native heart valve is a     native aortic valve. -   33. A valve support for a prosthetic heart valve, comprising:     -   a first row of first hexagonal cells at an outflow region of the         valve support, wherein the first hexagonal cells have first         longitudinal supports, first and second upstream struts         extending upstream from the first longitudinal supports, and         first and second downstream struts extending downstream from the         first longitudinal supports;     -   a second row of second hexagonal cells at an inflow region of         the valve support, wherein the second hexagonal cells have         second longitudinal supports, first and second upstream struts         extending upstream from the second longitudinal supports, and         first and second downstream struts extending downstream from the         second longitudinal supports; and     -   wherein the first and second upstream struts of the first         hexagonal cells and the first and second downstream struts of         the second hexagonal cells are the same struts. -   34. The valve support of example 33 wherein the first and second     longitudinal supports have a first width and the first and second     upstream struts and the first and second downstream struts have a     second width less than the first width. -   35. The valve support of any of examples 33-34 wherein:     -   the first and second hexagonal cells are directly adjacent to         each other such that the first longitudinal supports extend         directly from downstream apexes of the second hexagonal cells         and the second longitudinal supports extend directly from         upstream apexes of the first hexagonal cells; and     -   wherein the prosthetic valve assembly is attached to at least         one of the first longitudinal supports and/or at least one of         the second longitudinal supports. -   36. The prosthetic heart valve device of any of examples 33-35     wherein the valve support further comprises a first row of     diamond-shaped cells at a downstream end of the first row of     hexagonal cells and a second row of diamond-shaped cells at an     upstream end of the second row of hexagonal cells. -   37. The prosthetic heart valve device of any of examples 33-36     wherein the first row of hexagonal cells flares outward in the     downstream direction and the second row of hexagonal cells flares     outward in the upstream direction. -   38. The prosthetic heart valve device of any of examples 33-37,     further comprising connector extensions projecting from a downstream     end of the first hexagonal cells, and wherein each connector     extension has first and second struts forming a V-shaped structure     extending downstream from the first hexagonal cells, and a connector     projecting downstream from the V-shaped structure, wherein the     connector is configured to be releasably held by a delivery device.

From the foregoing, it will be appreciated that specific embodiments of the invention have been described herein for purposes of illustration, but that various modifications may be made without deviating from the scope of the invention. For example, several individual components can be interchange with each other in the different embodiments. Accordingly, the invention is not limited except as by the appended claims. 

I/we claim:
 1. A method comprising: positioning a capsule of a delivery device proximate a native heart valve; partially deploying a prosthetic heart valve device from the capsule of the delivery device such that an inflow region of a valve support and an inflow region of a fixation structure are expanded radially outward relative to the capsule with the inflow region of the fixation structure being spaced radially outward of the valve support, wherein a portion of the prosthetic heart valve device remains coupled to the delivery device while a gap exists between a downstream end of a prosthetic valve at an outflow region of the valve support and a distal terminus of the capsule such that fluid can flow through the prosthetic valve while the device remains coupled to the delivery device, wherein the prosthetic valve is within the valve support; and recapturing the prosthetic heart valve device within the capsule.
 2. The method of claim 1, wherein the native heart valve is a native mitral valve.
 3. The method of claim 1, wherein the native heart valve is a native aortic valve.
 4. The method of claim 1, wherein the prosthetic heart valve device further comprises arms coupled to the outflow region of the valve support and the fixation structure extends from arms along a smooth bend, and wherein recapturing the prosthetic heart valve device within the capsule comprises holding a downstream end of the prosthetic heart valve device while sliding the capsule over the arms and the smooth bend.
 5. The method of claim 1, wherein the gap is formed by connector extensions extending in a downstream direction with respect to the outflow region of the valve support.
 6. The method of claim 1, wherein the prosthetic heart valve device comprises: a plurality of arms configured to project laterally outward from the outflow region of the valve support and be inclined in an upstream direction in a deployed state, wherein the fixation structure is configured to extend upstream from the plurality of arms.
 7. The method of claim 6, wherein the fixation structure comprises a plurality of struts that define an annular engagement surface configured to press outwardly against the native heart valve and a plurality of fixation elements projecting from the struts.
 8. The method of claim 7, wherein a downstream-most portion of the fixation structure is configured to extend from the plurality of arms at a smooth bend, and wherein all of the fixation elements project from the fixation structure in an upstream direction.
 9. The method of claim 8, wherein the plurality of arms, the plurality of struts, and the plurality of fixation elements are configured to be at least partially deployed from the capsule and then at least substantially recaptured within the capsule.
 10. The method of claim 7, wherein each arm of the plurality of arms and the struts of the fixation structure extending from each arm form a Y-shaped portion of the anchoring member, and a right-hand strut of each Y-shaped portion is coupled directly to a left-hand strut of an immediately adjacent Y-shaped portion.
 11. The method of claim 1, wherein the valve support comprises: a first row of first hexagonal cells at the outflow region of the valve support, and the first hexagonal cells having first longitudinal supports; a second row of second hexagonal cells at the inflow region of the valve support, the second hexagonal cells having second longitudinal supports, wherein the first and second hexagonal cells are directly adjacent to each other such that the first longitudinal supports extend directly from downstream apexes of the second hexagonal cells and the second longitudinal supports extend directly from upstream apexes of the first hexagonal cells; and wherein the prosthetic valve assembly is attached to at least one of the first longitudinal supports and/or at least one of the second longitudinal supports.
 12. The method of claim 11, wherein the valve support further comprises a first row of diamond-shaped cells at a downstream end of the first row of hexagonal cells and a second row of diamond-shaped cells at an upstream end of the second row of hexagonal cells.
 13. The method of claim 11, wherein the first row of hexagonal cells flares outward in the downstream direction and the second row of hexagonal cells flares outward in the upstream direction.
 14. The method of claim 11, further comprising connector extensions projecting from a downstream end of the valve support and/or the base, and wherein each connector extension has first and second struts forming a V-shaped structure extending downstream from the valve support and/or the base, and a connector projecting downstream from the V-shaped structure, wherein the connector is configured to be releasably held by a delivery device. 